DBT for Anxiety

Are you struggling with anxiety?

Anxiety can be tough to live with. Symptoms of anxiety include the following:

• Often feeling nervous, anxious or on edge

• Not being able to stop or control worrying

• Having a hard time relaxing

• Being so restless that it is hard to sit still

• Becoming easily annoyed or irritable

• Feeling afraid as if something awful might happen

• Avoiding situations, places, objects, or activities that worsen anxious feelings and thoughts

• Having physical symptoms, such as sweating, nausea, shaking, feeling faint, or having trouble breathing

• Spending an excessive amount of time preparing for situations, places, objects, or activities that worsen anxious feelings and thoughts

• Frequently feeling overwhelmed by worries and fears

Dialectical Behavior Therapy is an evidence-based therapy for a variety of conditions, including severe anxiety. 

When practiced, DBT skills can help reduce the intensity of anxious feelings, freeing up emotional space so you can behave in a way that’s in greater accordance with your goals. After completing DBT treatment, many of our clients have reported being able to form a new relationship with their emotions, one in which they’re no longer controlled by fear.

DBT is useful for anxiety because it involves learning a set of skills that apply to real-world situations. You can use a DBT skill in almost any anxiety-invoking situation – regardless of if you’re getting ready for a presentation at work or meeting someone new for the first time, there’s likely a DBT skill that’s relevant to your situation.

DBT In Action: Skills That Help Prevent Burnout and Blindspots

If you’ve ever watched a car race, or even a scene from an action movie, you’ve probably witnessed a “burnout”. This is when the driver stomps on the gas from a complete stop, causing the tires to spin, squeel, smoke, and burn. This is not good for the car, the tipres, and certainly not good when we do it to ourselves. Racing thoughts associated with anxiety can cause their own sort of burnout — panic attacks, spinning minds, and burning up of energy stores.

There are many DBT skills that are useful for coping with anxiety. When used in combination, these skills deliver the ability to pump the brakes on the cognitive and physical symptoms that can often lead to panic attacks, poor decision-making, and intense discomfort.

Often when people experience fear, their brains exaggerate how threatening the situation in front of them is and respond with the same physical symptoms of fear (flight, fight or freeze) that it would if the person were truly faced with a life-threatening situation. In these cases, it’s helpful to BOTH regain control of your physical and cognitive senses by separating what you know to be factual in a given situation from what is an assumption. 

In the moment, it can be pretty hard to tell the difference between the facts of a given situation and the fear-filled stories that your brain tells you in an effort to predict the future, espcially when your body is telling you to FREAK OUT!

Below is a case study to show what happens when we don’t use skills and what can change when we do.

Old Patterns Cause New Havoc

Layla is at her desk at work, and it’s 10 am. Her boss has just sent her a message that says “Hey, I need to see you at 2 pm, stop by my office then.” 

After reading this message, Layla’s mind is off to the races. She immediately thinks, I’m about to get fired, this is awful, I’m in so much trouble. I am going to have to move back in with my mom.

She can feel her heart rate increase and starts nervously pacing around in her office like a lion in a cage. She can’t think about any of her other work, because all she can think about is what her boss might say to her. 

Layla spends the next few hours nervously fidgeting during meetings and isn’t able to make progress on any of her projects. She can’t focus on anything, all she can think about is how terrible it’ll be to tell her parents that she got fired. She feels sick, and can’t eat lunch. 

When 2 pm comes around, Layla slinks, head down, towards her boss’s office, hand shaking as she knocks on the door. Her boss opens it and greets her with a smile. It turns out she wanted to tell Layla that she did solid work on the last project she completed and that she was impressed by the effort Layla put in. Phew! What had she been so worried about?

DBT Skills Put the Brakes on Racing Thoughts

As you can see, anxiety is a full body and mind experience. Stopping the circular thoughts and panic spiral means intervening within both the cognitive (thought-related) and somatic (body-related) feedback loops.

Now, let’s rewind that situation, and give Layla a few new skills. . .

Having just read the message that her boss sent her, Layla immediately starts worrying if she’ll get fired. However, this time, she uses the skills of Mindfulness to tune into her body and notices her heart rate climbing and her breathe quickening. She then uses another skill called Paced Breathing to slow her breathe and heart rate.

With her body under control, she is able to recall the DBT skill, Check the Facts, that she had just learned about in skills group the past week. Layla opens up her DBT app and goes through the steps of the Check the Facts skill. 

Step 1: What are the things I’ve observed through my senses that I know to be facts?

• My boss sent me a message this morning at 10 am.

• It was on Slack.

• She wants to see me in four hours.

• She wants me to come to her office.

• This isn’t the first time she’s sent me a message like this. She’s asked me to come to her office in the past, I can see those messages from her right here, and she didn’t fire me then. . 

Step 2: What judgments and assumptions am I having that aren’t facts?

• I’m assuming something is terribly wrong.

• I’m assuming I’m about to get fired.

• I’m assuming she’s going to yell at me and I’ll cry and it will be terrible. 

Step 3: Am I assuming a threat? Can I label the threat?

• Well, yes, I’m assuming I’m about to get fired. 

Step 4: Are there other possible outcomes?

• Yes. It could be my boss wants to know something about one of my clients.

• Or she might want to know if we closed the deal from yesterday.

• I guess there are a lot of things she might want to know about, that don’t involve me getting fired. 

Step 5: What’s the probability of me getting fired versus it being one of these other things?

• Probably pretty low – she’s not really in the habit of randomly firing people. No one on my team has been fired while I’ve been here. And the other times she’s messaged me to come to her office, well, it’s always been about normal stuff, not getting fired. 

With the New Skills and Support of a DBT Program, Healthier Patterns Emerge

While Layla is still nervous after finishing the Check-the-Facts skill, she’s not overwhelmed with gut-wrenching anxiety. She’s able to focus on her work and makes progress on her tasks.

She uses another DBT skill, the TIPP skill, to decrease the tension in her body when her anxiety periodically flares up throughout the day. She reminds herself of what she discovered while using the check the facts skill to calm her racing thoughts.

Layla also makes use of interpersonal effectiveness skills, particularly the DEAR MAN skill, to briefly ask her boss what their meeting will be about. While still nervous, Layla experiences relief when her boss says, “oh, it’s a good thing,” with a genuine smile.

Instead of being a prisoner to her own anxiety for hours, Layla is able to distract herself until she goes to her boss’s office, and is complimented by her boss for her work performance. 

DBT Skills can prevent unnecessary suffering. There’s a way out of anxiety!

When we look at the two versions of the same situation above, they tell two very different stories. One involves hours of suffering and the miserable experience of being stuck in one’s own head without relief. The other involves the same prompting event, but a very different reaction that drastically decreased the amount of suffering involved. 

This is the power of DBT skills – even when we’re in a situation where we lack external control over something that causes us fear, we can take steps to decrease the toll that it takes on our mental well-being. 

ready to make a change?

If you’re suffering from intense anxiety, DBT can help. Use the below link to contact us today.